Brockville General Hospital - Patient Survey

1. Patient Survey

Your views about our Patient Care Services are very important to us. Your experience will help us to improve existing services and influence our future plans.
Please take the time to complete our survey by rating the questions below. The survey should only take approximately 10 minutes. Note: once you start the survey you can not save it and return to it later.
1. Please provide your contact information:
Or if you wish to remain anonymous, please only enter your postal code.
2. Please rate each of the following questions:
Received all of the required information in advance of your visit
Convenience of your appointment time (if applicable)
Your privacy/confidentiality was respected at all times
Comfort and pleasantness of patient area
Courtesy and professionaliam of our staff
Care provider introduced her/him self to you by name and occupation
You were called by the name you prefer to be called by
Explanation of any procedure(s) and education material(s)provided to you by nursing staff
Explanation of any procedure(s) and education material(s) provided to you by Physician
Efficient response to your inquiries or requests
Cleanliness of your room and the hospital in general
Quality and quantity of food and service delivery, if hospitalized
Overall impression of the quality of care you received
Ability to find your way in the hospital was easy
3. Please indicate where you received services while in the hospital?
CCC- Charles St.Site
GSS- Garden St. Site
4. Would you be willing to participate in a Patient Focus Group to represent the community in the future?
5. Please provide any additional comments.
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